Four months, three weeks, and two days of poor arguments.

I have little to say on the murder of Dr. Tiller than hasn’t been covered adequately elsewhere (e.g.). But two persistent points have been getting on my nerves regarding late-term abortion in which Dr. Tiller had specialized. So let’s have some data.

1) The focus on late-term abortion, especially the straw-fetus of frivolous late-term abortion. The typical discussion runs as follows: a very serious person argues that while he’s personally comfortable with first trimester abortion, the thought of a woman wandering in and deciding that she doesn’t want her baby in week 35 of a pregnancy is horrifying. (e.g., makes him want to puke.) And let’s accept for the sake of argument that it is horrifying.* What can the pro-choice advocate say?

First, that late-term abortions are really, really rare. Here’s a chart from the Guttmacher Institute.

The full document is here. The chart shows percentage of abortions by week of gestation. Note that the vast majority are in the first trimester, and over half are before 9 weeks. (The answer to “Abortion stops a beating heart” should be “Well, about that…”; the heart isn’t beating before five weeks.)

But let’s look at the late-term abortions. Only 1.1% are after more than 21 weeks. 21 weeks is about two weeks shy of the lower-end of viability. 21 weeks is still in the second trimester. We can safely assume that the number of abortions in the third trimester is even smaller, especially because abortion after 24 weeks is generally not permitted by law except in cases of danger to the health of the mother and the fetus.

Let’s have some more context. One commonly-cited reason for abortion past the first trimester is the presence of fetal abnormalities, including Down syndrome and other fetal abnormalities. These are usually detected on an ultrasound and confirmed via amniocentesis. Amniocentesis is somewhat risky, so it’s usually performed only if there’s a reason to suspect an abnormality. And the usual time to find an abnormality would be during the second trimester ultrasound, usually around 18-20 weeks, sometimes a bit earlier. It seems reasonable to conclude that many of the abortions performed post 21-weeks are due to the discovery of some sort of anomaly. Moreover, medicine can’t catch these abnormalities significantly sooner than they are discovered.

So, we’re well under 1%, and we haven’t even made it to the types of cases that would need the attention of someone like Tiller, who performed abortions after 24 weeks when there was a sufficient medical reason. (He turned women away sometimes.) What do those look like? There have been many heartbreaking stories circulated around the Internet following Tiller’s murder. You can read some of them here. This one is typical, if “typical” can be used to describe such a sad situation. Note a common theme: a pregnancy that is going well, until suddenly it isn’t, and then a couple has to make an absolutely heartrending decision. Note that simply letting nature take its course can be equally heartbreaking (can you imagine knowing your child would not survive long past birth, and having to hear the well-wishes of well-intentioned acquaintances? )

At 1.2 million abortions per year, 1.1% is about 13,200 abortions. I mention this because late-term abortion looms much larger as a reason to oppose abortion than it should given its rarity. It’s also important to note that past 24 weeks, the laws do not permit abortion that isn’t tied to reasons of life and health (fetal or maternal). People primarily worried about late-term abortion need to understand what it is that they’re worried about, understand that what they’re worried about is already heavily regulated, and then need to make the case from there, based on the cases that actually occur. It allows us to formulate the problem in terms of specific questions. This doesn’t make the answers easy, or rid us of potential ethical questions. But it at least ensures we’re not debating the abortion-equivalent of the ticking-time bomb. To do otherwise is simply not based in reality.

2) Roe. Roe Roe Roe Roe Roe. If you didn’t read the case, and just went by Internet discussion, you’d come away with the impression that Roe not only made it impossible to regulate late-term abortion, but that it was the only case that had ever been decided concerning abortion. The actual finding of Roe? The state has no compelling interest in regulating abortion in the first trimester, and needs to provide for a life-of-the-mother exemption in the later term. The actual case out of which most of the current regulation is based? Planned Parenthood v. Casey, which introduced the undue burden test, which allows for certain amount of state intervention even in the first trimester.

Now, if one is against abortion full-stop, one probably won’t be moved by the health of the mother or the age of the fetus or the amount of regulations in place. And one is free to make that case. (It’s interesting, though, that Tiller drew the ire he did because of the age of the fetuses.)

But most Americans seem to be okay with abortion in the first trimester, a little squeamish about abortion in the second trimester, and really not sure about abortion in the third trimester. Given that, it’s incredibly important to know what the laws are, and what’s actually at stake.

Update: CommenterNorth provides this helpful fact sheet from FOXNews, which tells us that there are approximately 100 abortions per year performed after 24 weeks gestation, around 0.01% (rounded up.) Late-term abortions are very, very, very rare.

*There are good arguments that what one finds personally horrifying really shouldn’t matter to the legality of abortion; I just wanted to set aside that question entirely.

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39 comments

*snorts* at the footnote. I think I have a solution here that will satisfy everyone!

I find severe fetal defects like brains developing outside of bodies and conjoined twins with no hope of survival and, for that matter, fetuses dying inside their mothers’ wombs, personally horrifying. Let’s just make that stuff illegal! Then, no more need for late term abortions. Woo hoo! The pro-lifers will LOVE this idea, it’s so consistent with their current understanding of reality…

Here’s a 2003 Fox fact sheet on abortion that claims that the number of abortions after 24 weeks is about 100. That’s .006% of total abortions (their figure in the same article is 1.6 million). It’s a tiny, tiny percentage of abortions. I won’t rehash the argument I’ve made on my blog, but I don’t understand people’s lack of sympathy for the 100 women a year who are in desperate enough circumstances to need a third-trimester abortion.

Megan McArdle thinks Tiller was “vivisecting” human beings and moreover doing it “without anaesthesia”. A brief search indicates that anaesthesia for both mother andunborn infant is routine in these cases, at least where the unborn could plausibly feel pain.

Of course, you can’t win with these people: because there might be pain, it’s murder. My “routine” overstates frequency: Wikipedia reports that Tiller was working at one of only three clinics in the U.S. that performs late-term abortions.

Like we needed this, now. It’s like Kevorkian red meat with hot Schiavo sauce, only with the macabre garnish that Tiller was assassinated while assisting at church services. (Damn librul Lutherans!) If there’s a silver lining, it’s that the GOP, whose left wing now consists mostly of rapidly departing Reagan Republicans, will very likely, in the name of “stoking the base”, shoot itself in the foot on this issue, over and over, until there’s no foot left. Then, if we’re really lucky, it’ll draw a bead on its other foot and . . . .

I know, right? I didn’t know until the other day. One reason is the cost and logistical difficulty: a woman at my town’s Tiller vigil talked about getting a teen-ager who’d been raped to Kansas. It cost at least $5000, was a 3-day procedure, and involved a coast-to-coast fundraising effort followed by a coast-to-coast logistical effort, with the girl and her mother being dropped off and picked up at train stations by volunteers, fed and housed by clinic supporters in Wichita, frantically reading the girl her informed consent papers before she got on the train, and, in a last minute twist of drama, finding out at the train station in my town that the girl’s ticket had been canceled by an Operation Rescue mole in the sheriff’s department. So the woman who spoke paid for the new ticket with her Pell Grant funds and got the girl and her mother on the train while the boarding agent held up its departure for the extra few minutes they needed.

The Longer OED marks “having the character of a prostitute” with the “obsolete” dagger.

I know perfectly well what a meretrix is, as far as giving a definition goes, and “meretricious” (which does indeed derive from “meretrix”) wouldn’t mean what it does, did meretrix not mean what it does—but it’s not as if even meretrix has one correct set-forever meaning. Had I called her a meretricious mendax, would that have been better for using the english adjective rather than the latin noun?

I wouldn’t shrink from calling, say, David Brooks a meretrix (meretor?), if that helps.

One of the reasons that she gets so much criticism, IMHO, is that she’s a larval Friedman/Broder/Cohen/Dowd/etc.

It was previously believed that such things were born middle-aged (and white males, even if they were female or
non-white, if you get what I mean), so this is a fascinating discovery. Twenty years from now, when you hear some young thing comment on her, you’ll be able to say that you knew Megan when she could do a passable imitation of a human being.

I just posted this comment on Ezra Klein’s blog where you were quoted: :-)

WHAT WE ARE DEBATING WHEN WE DEBATE SECOND-TERM (AND EVEN FIRST-TERM) ABORTION

Many abortion providers wont do post 10 week abortions for fear of killing (murdering: in their conception) 14 week old fetuses because of the normal 2 week error range.

I have always thought that when artificial wombs become technically possible 14 week gestation babies will be considered legal persons just on our emotional reaction to their large size. (I hope most of us can leave born/unborn behind as relevant to right/wrong in this discussion.)

What status to give fetuses near 14 weeks — possible human life? Possible human life is where Roe took off and flew from reality. Possible human life would seem — ipso facto — to represent a compelling state interest: Roe’s supposed requirement for legislatively overriding fundamental constitutional privacy.

Roe was perfectly logical until it got to possible human life which it had to evade to get to where it wanted to go — with the words: “We do not agree that Texas, just by ADOPTING ONE THEORY OF LIFE, may override the rights of the pregnant woman that are at stake.

No, Denis, most physicians do not do termination or evacuation procedures past 12 weeks because it is a completely different medical procedure, based on the gestational age and size of teh products of conception. Physicians choose what procedures they do and which they refer out all the time. It is a more complicated procedure, and requires additional training and practice. This training is difficult to get and, as you can imagine, highly stigmatized, thanks to uninformed yet opinionated people like yourself.

I am not sure where you are getting this magic 14 weeks number. (Is ipso facto that magic words that makes your opinion suddenly a medical fact? I think it may be, in your mind.) The American Academy of Pediatrics does not recommend any resuscitative measures before 24 weeks gestational age. Any procedure after that gestational age is extremely rare (see original post) and tragic. These women do not need to be kicked around by conservative, anti-choice fact magicians.

I thank you for providing a simple bit of data and context that so clearly (though obliquely) illustrates the mania that drives the anti-choice movement. However, I wish you would have expanded a bit more on WHY late-term abortions are typically performed. I started to seriously ponder that question when Dr Tiller’s assassination occurred last Sunday.

My curiosity about this question led me to do a little research, and I discovered that beyond Down’s Syndrome, there are numerous other HORRIFYING birth defects I’d never heard of (harlequin syndrome, cloverleaf skull are just two). Most birth defects seem to occur due to genetic defects that reveal themselves through brain, bone, skin and spinal cord malformations. If delivered full term, most of these unfortunate little spirits live a highly painful few minutes, hours or days before expiring. If the baby does live for more than a few minutes and there is any hope of sustaining life, it is immediately hooked up to all sorts of tubes, given an assortment of drugs, and surgeries are performed. Simply… the short life of such a child is a hellish existence…something I would not wish on anybody, and certainly not a small, vulnerable soul that has just begun breathing air.

The babies who are able to “survive” must endure sometimes hundreds of painful surgeries to correct their physical deformities (deformities that often impede basic bodily functions). Their existence is highly limited, typically characterized by severe developmental disabilities (neurological and physical) requiring a lifetime of intensive medical care, to be performed either by a family member or a team of nurses. I can’t imagine the pain and suffering endured by the child (and their family), nor the expense incurred by the family and government programs.

After learning so much more about the birth defects requiring late-term abortion, I also surmised that the women who require these abortions must — in most cases — prefer to deliver a live, healthy baby than abort it. I would imagine that choosing to and then experiencing an abortion in this situation would be simply devastating.

If it were me in this situation, and I had an ultrasound or amniocentesis that revealed severe abnormalities, I would certainly want the choice to terminate and be able to find a provider who would do the procedure without fear of being murdered. I am most saddened and disturbed to know that one rare (and very benevolent, it seems) provider of this procedure is gone. I can’t tell you how much I would not want to hear from my Ob/Gyn “Well, there used to be a doctor named Tiller in Kansas…”

It is beyond understanding why a group of people would feel justified assassinating a physician who performs abortions that are just over 1.1% of all abortions performed, and is typically a medically necessary procedure. But as it goes, the people in the anti-choice movement seem to only look at the facts that work for their agenda.

We can all argue about whether aborting a fetus is murder, and I’m sure we will continue to do so. But it should be up to the mother and her family to decide if they are mentally, physically and financially prepared to raise a special-needs child. And this is just one of many situations that might require a late-term termination. It must be an individual’s choice and there MUST be providers available to perform the procedure.

MomTFH,
I said “possible” human life is “ipso facto” a compelling state interest — equal to the test of overriding fundamental constitutional privacy.

I read in the prochoice book “Caught In The Crossfire” that some providers will not do beyond 12 week procedures for fear of killing (murdering in their view) a 14 week baby under the normal 2 week error range. That recognition by even some abortion providers and the size of a 14 week baby makes me confident (on a common sense basis, no “magic”) that 14 week old fetuses will be recognized as legal persons once artificial wombs are extant.

Under Roe, viable babies may be killed (murdered?) if the mother can merely get a physician to sign off that she will be depressed if she carries the baby to term.

Denis, I was trained to do a first trimester evacuation by Medical Students for Choice, and have attended lectures on the different procedures. I assure you that the reason that practitioners stop at twelve weeks is that a different procedure is needed beyond that time. The age of even possible viability is 24 weeks.

Read the original post. Women who desperately need these procedures get them. I am not sure why you seem to think that women are purposefully waiting until after viability and then getting physicians to lie. I think it is sad that you are misrepresenting the patients who need these procedures. These are suffering women whose stories you can easily read about, but you would rather lie about them.

Roe is not the current law of the land. It required a life of the mother exemption to any ban on abortion post-viability. Current law now in Kansas, which permits very late-term (i.e., viable, 24 weeks), there has to be significant risk to the health of the mother and/or significant medical problems with the fetus and TWO doctors have to sign off on it. And, again, we’re talking 100 terminations per year after 24 weeks.

Viability is not at fourteen weeks. Nothing is well-formed enough, even if the fetus weighs a whole two ounces, to survive outside the womb. The fetus is just starting to make its own blood cells. Functional lungs are ten weeks in the pipeline. Twenty-three weeks is about where it is now (for some value of “viability”) due to limits on equipment, but in some ways it’s looking like a hard wall.

My guess would be that the providers aren’t working off of where they think viability will be in the future, but on the different laws in their state depending on whether it is first or second trimester (i.e., the 14 week line), or on their personal beliefs about personhood. But it isn’t because of a well-established scientific belief in viability at 14 weeks, or a well-established scientific prediction about where viability will be.

Once artificial wombs are a common thing? Who the hell knows how that will affect how we feel about abortion? We can get back to that question in two or three generations.

For some reason, after Dr Tiller’s murder, I have suddenly become deeply involved in trying to understand late term abortion. Being childless by choice, it’s simply something I’ve never given much thought.

In my reading, it’s CLEAR that no woman ever “just gets an abortion.” Being pregnant is an exciting time filled with dreams and love and thoughts of the future. It is nothing but devastating to even consider you might have to terminate not only the life of your child but also the dreams you’ve created for your family. So nobody just decides to kill their baby because it won’t come out perfect. These decisions are made when defects arise that are incompatible with life.

If you really want to understand the deeply painful struggle mothers and fathers endure when it’s evident a termination is required, visit this website and read some of the stories.

MomTFH,
I said they stop at 10 weeks, not 12 — or should I say the book said so.

Dana,
Viability is no measure of humanity.

Why did Roe pick viability as the “compelling interest” point in gestation? Roe did not say. America’s most quoted liberal law professor Laurence Tribe, quoting a young Yale Law professor who would soon be president of Stanford Law, John Hart Ely on viability: “Truly this mistakes “a definition for a syllogism” and offers no reason at all for what the Court has held.” (HLR, Vol. 87:1, p. 7)

Shades of Roe dodging its own compelling test where possible human life is concerned.

Roe’s viability line seems much less concretely based than my guess on how we will (subjectively) feel about 14 week old fetuses in artificial wombs — or my observation of how even some providing doctors feel about 14 week old fetuses.

Denis, did you read the title and decide this was the place for poor arguments? Why are you still talking about artificial wombs? When will you go read the original posts and the stories at the links provided to you and realize we women are NOT ARTIFICIAL WOMBS.
I can only imagine you keep discussing this freak medical invention so you can keep pretending that women do not matter in this equation. Note the heartless comment above.

You have not answered why a doctor would consider a 14 week old pregnancy has more of a measure of so called “humanity” than a 12 or 1o week one. And, frankly, I don’t think anyone cares but you.

However, I wish you would have expanded a bit more on WHY late-term abortions are typically performed. I started to seriously ponder that question when Dr Tiller’s assassination occurred last Sunday.

You know, I thought about this, but I didn’t for a couple of reasons, though I did link a few stories in my post. One, the sad stories were being given adequate coverage on other blogs.

Two, I suspect that some people would be moved by those stories, but inclined to dismiss them as cherry-picked outliers. “Sure,” the person might say, “some people terminate their pregnancies for tragic reasons, but that can’t be all of those late-term abortions, and we surely have to worry about the epidemic of women deciding that they’re mildly depressed and deciding to abort healthy viable babies.” I thought the combination of the numbers and the actual laws would undermine that line of thinking. 1.1% of all abortions, with a scant 0.01% coming after the earliest signs of viability, with somewhat restrictive laws makes it very, very plausible to hold that every single post-viability abortion is a medical necessity.

The other thing that might be worthwhile to mention is how hard the mother and doctors will work to keep the pregnancy going when there are complications and the mother and baby are threatened, but otherwise healthy. No one’s pushing for abortions post-viability, even when there’s significant risk. A friend of mine got hit with the double-whammy of gestational diabetes and pre-eclampsia. Everything they did after the diagnosis was to minimize physical stress on her to give the baby more time to finish growing its lungs, because they knew that eventually, her blood pressure would spike, and the baby would have to come out right now. And her blood pressure did indeed spike, and they did indeed perform an emergency C-section, and her son was, to the surprise and delight of everyone, perfectly healthy, just very small.

I will start by saying I used to be “pro-choice” until I had my son. He was born at 31 weeks weighing 3lbs. 1oz. When I saw him and saw how alert he was, how smart I knew he would be, his hair,finger nails,smell everything, I became very pro-life. I believe life begins at conception. We knew our son would have “problems” and be put on “tubes” and also endure surgery. I am so happy we made the decision to have him. He pulled through it fine and is the best thing to have ever happened to us. I encourage anyone who is “pro-choice” to visit a NICU, just once. You may look and say “oh these poor babies, hooked up to everything, must be torture” but coming from where I came from I now say” wow what a blessing to have these beautiful babies”!

I don’t think shooting someone who performs abortions is the right choice at all and makes us pro-lifers look bad I know. However there is a argument of “1.1%” well that is 1.1% too much. My son was a 31 weeker. I know what that looks like. I think let nature run it’s course. If it is my time, I go. If my baby is too ill to make it so be it. The thought of somewhere downtown where I live are trash bags behind some abortion clinic full of dead babies is gut wrenching to me. I do feel bad that a woman thinks she has no other choice and decides to terminate that precious life that is in her body. I get that some women have to “make a choice” later in their term. But down Syndrome ? You would kill a baby for that? It’s not even their fault but is genetic so why blame them? I honestly look at someone who terminates their pregnancy over that as a coward. I have spent a good part of my life working with special needs kids and adults. Believe me, they are so worth keeping. It seems like some people look at their kids as an accessory to their house, job and car and not a human being. How can anyone say get rid of it due to mental retardation?

I don’t think we as a country are where we need to be with abortion. The big problem I have too is how many a woman can “choose” to get. I knew someone that had 5 of them! When do we say OK, maybe you need to tie your tubes, IUD, a condom or just keep your legs closed! I don’t think one night stands should be good enough a reason to have an abortion.

I just read your comment and visited that site and read some of the stories.

I have a sister that was told her fourth son would be born with clubbed hands and feet, scoliosis(which my son has) and may never walk and be faced with a long line of surgeries. Did she chose to abort him? No. Am I glad she made that choice? yes. Does it make me a “heartless beast”? No.

Peyton is a bright, healthy and funny little boy. We are so blessed to have him in this world :)

I think you are all missing that this is a completely valid choice. Making abortion legal does not prevent most women and physicians opting to take the chance on a possibly debilitated child. Late term abortions are so rare, out of millions of births a year, less than 100 are late term abortions in the United States. We are talking about extreme cases here. No one is advocating aborting every possibly damaged child.

The fact that Tiller and others were targeted specifically for performing late-term abortions indicates that the anti-choice crazies don’t actually believe their own ideology. If personhood begins at conception then a late-term abortion is no better or worse than any other.

Christie, it’s not 1.1%. It’s 0.006%. That is ; that is, 6 in 100,000.

This is not about what YOU would do. The person most affected by the decision should be the one making it. And you did not face their choice.You had a premature baby well within the limits of viability and in fact more mature than any of the third-trimester abortions I’ve read about. Walk a mile in their shoes! Anti-abortion protesters sneak in for abortions, too–when it’s them, suddenly things look different.

Would you give someone your kidney? Would you want a law that said you had to give someone your kidney if they asked?

One study found that, about 35% of third-trimester abortions were because an earlier screening, which *might* have found a severe defect, gave a false negative. About in about 40%, a problem was found in the second trimester but the doctors waited and did further testing to see how severe it was. In about 20%, the defect can not be diagnosed until the third trimester. We’re up to 95% now. And in 5%, parents and doctors knew in the second trimester that they should abort, but did not or could not act on it right away.